Evaluation Report

HEE North Central and East London &

NIHR CLAHRC North Thames

Clinical Nurse/Midwife/AHP (NMAHP)

Academic Fellowship Scheme

NIHR CLAHRC North Thames

Dr Victoria Louise Newton

Professor Naomi Fulop

with support from Anna Head

December 2017

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HEE North Central and East London & NIHR CLAHRC North

Thames Clinical Nurse/Midwife/AHP (NMAHP) Academic

Fellowship Scheme

Evaluation Report

For further information please contact:

NIHR CLAHRC North Thames Academy

Department of Applied Health Research

University College London

1-19 Torrington Place

London WC1E 7HB

Email: clahrc.academy@ucl.ac.uk

Acknowledgements

The authors would like to thank the HEE North Central and East London & CLAHRC North

Thames Fellowship Scheme Steering Committee for their invaluable feedback on the draft

report and emerging findings. We would also like to thank all the evaluation participants who

freely gave their time to provide an interview, and for their feedback on the draft version of

the report.

The Fellowship scheme was funded by Health Education England (HEE). National Institute for

Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care

North Thames at Barts Health NHS Trust delivered the scheme and funded the evaluation.

The fellowship scheme and evaluation were supported by Health Education England (HEE).

The views expressed are those of the authors and not necessarily those of the NHS, the NIHR,

HEE, or the Department of Health.

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Introduction

One aim of the NIHR Collaborations for Leadership in Applied Health Research and Care

(CLAHRCs) is to increase the capacity and capability of the nation’s health professionals to

undertake high quality applied health research. The Shape of Caring review highlighted a

need to generate a greater research culture in nursing, with all nurses being involved in

supporting or leading research in the future (Willis 2015). In response to this report, the

CLAHRCs have been working to create new pathways to support nurses, midwives and allied

health professionals and to build the capacity of this workforce to undertake applied health

research (NIHR 2016).

There is an increasing evidence base regarding the positive impacts that research-active

Trusts have on patient outcomes through the embedding of evidence-based practice (Willis

2015; Ozdemir et al 2015; Boaz et al; 2015). As highlighted in Modernising Nursing Careers:

Setting the Direction (Department of Health 2016), developing a highly skilled workforce of

nurses, also in research work, is an important aspect of preparing the profession for the

challenges of the current and future healthcare service. UKCRC’s Developing the Best

Research Professionals report (2007) made recommendations including the development of

a clinical academic pathway for nurses, involving training award schemes, flexible working

arrangements for combining clinical and academic work, and mentorship. While these

reports focused on the nursing profession, parallels were made across the healthcare

professions, resulting in these recommendations leading to the establishment of a clinical

academic pathway and training across the healthcare professions.

The NIHR/CNO/HEFCE Clinical Academic Training Programme ran from 2009 to 2015,

awarding 77 doctoral fellowships, 36 clinical lectureships, and 13 senior clinical lectureships

to healthcare professionals over this six-year period (NIHR Trainees Coordinating Centre).

Following a review in 2014 by Health Education England (HEE), this was replaced in 2015 by

the NIHR/HEE Integrated Clinical Academic Programme for non-medical healthcare

professionals. A key feature of the integrated programmes is that emphasis is placed on

both academic and clinical progression. When the evaluation was undertaken, the pathway

was formed of four stages of awards ranging from Masters studentships in clinical research,

to clinical doctoral research fellowships, clinical lectureships, and senior clinical lectureships

(HEE 2015). Other sources of funding, training, and fellowship awards come from a variety

of sources, such as CLAHRCs, regional partnerships between trusts and HEIs, charities, and

other such organisations (NIHR 2016; AUKUH 2013; AUKUH 2016).

Since 2015, NIHR CLAHRC North Thames and Health Education England’s (HEE) north central

and east London team (now part of the north London local team), have been working

together to develop a novel one-year fellowship scheme for nurses, midwives and allied

health professionals (NMAHPs), which aims to promote clinical academic pathways and

develop the research leaders of the future. The scheme involves the secondment of NMAHP

fellows for four days a week to a research department in CLAHRC North Thames, allowing

the fellows to work on a project of their own choosing, or on a current CLAHRC project. The

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scheme facilitates this secondment by backfilling the fellows’ salary for three days a week,

while the fellows’ employing organisation is required to fund the fourth day of the

secondment. The fellows spend the fifth day as normal, remaining in clinical practice at their

organisation.

HEE/CLAHRC fellows are recruited from across the North Thames partnership via a

competitive selection process. In spring 2015, the first cohort, comprising three fellows,

began secondments to the CLAHRC. In 2016, a further two fellows were recruited. A third

cohort of four fellows was recruited in March 2017, and a fourth cohort of four fellows was

recruited in August 2017. This present report focuses on evaluating the first two cohorts of

the scheme (2015 and 2016).

During the secondment, fellows are provided with support and mentorship by a senior

CLAHRC academic in order to develop an application for doctoral or post-doctoral research

funding (for example, by applying to the HEE/NIHR Clinical Doctoral Research Fellowships).

They also have access to peer-to-peer mentoring and networking during the fellowship, as

well as to the full range of Academy training opportunities. In line with the goal of building

research capacity across the CLAHRC, fellows are required to undertake activities to raise

levels of research awareness at their base NHS organisation.

Evaluation Aim & Objectives

The aim was to evaluate the 2015 and 2016 HEE/CLAHRC Research Fellowship Scheme for

nurses, midwives and allied health professionals, in terms of its impact on the fellows, the

local health care system and on CLAHRC North Thames.

There were five main objectives:

1. To assess the success of the scheme with regard to supporting NMAHP fellows to

complete applications for external doctoral research funding, and the outcome of

those applications

2. To describe the wider impacts of the scheme on the fellows’ research careers,

their base NHS Trusts and their host research organisations

3. To explore the experiences of those involved in both participating in and running

the scheme, including their recommendations for the future

4. To examine the effectiveness of the advertising and recruitment process, including

perceived barriers to participation

5. To contextualise the scheme with other national initiatives aimed at supporting

NMAPH research careers and to identify key areas for learning

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Methods

We carried out 221 semi-structured interviews with a number of different stakeholder

groups and analysed questionnaires on the fellows’ progress from Cohort 1 and 2.

Table 1: Stakeholder Participants

Stakeholder Data collection method

Fellows progress questionnaires; 4

interviews

Scheme Steering Group Members 4 interviews

Fellows’ Supervisors 4 interviews

Fellows’ Line Managers at Host Trust 3 interviews

Local Clinical Academics 4 interviews

Senior Representative from a Trust who did not

participate in the scheme

1 interview

Senior Representative from participating Trust 1 interview

Representatives from other CLAHRCs running similar

schemes

2 interviews

Component 1 – Questionnaire

In order to assess the success of the scheme with regard to the opportunities for applying

for external doctoral research funding (obj. 1), we used quarterly progress questionnaires

submitted by all the fellows from cohort 1 and 2 (n=5) to examine the following points:

The success of personal research fellowship applications

Research outputs during the fellowship

Training courses completed

Activities to raise levels of research awareness within their Trust

Other engagement activities

1 One interviewee was a member of the steering group, and a supervisor. This interviewee has been counted twice in the table below.

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Component 2 – Semi-structured interviews

In order to explore the wider impacts of the scheme and the experiences of those involved

in the scheme, including their recommendations for the future (obj. 2 and 3), we conducted

15 semi-structured interviews (one interviewee straddled two groups), comprising:

Four2 NMAHP Fellows

Four3 Fellow Supervisors

Three Line Managers in base Trusts

One Director of Nursing at a Trust engaged in the scheme

Four4 members of the scheme’s steering committee

These interviews explored reflections on participation in the scheme, including the impact

of the scheme on host NHS organisations, from the perspective both of the fellows and their

wider professional support network. Topics for discussion included arranging a secondment,

the impact of the scheme on the fellow and his/her career, and any challenges or barriers to

participation.

To examine the effectiveness of our advertising and recruitment process, including

perceived barriers to participation (obj. 4), we conducted 5 semi-structured interviews with

groups who did not directly participate in the fellowship. These were:

One Director of Nursing (or equivalent senior representative) in a local Trust who did

not engage with the scheme

Four Senior Clinical NMAHP Academics in local universities

Interviews explored awareness of the scheme, NMAHP career progression pathways and

barriers to participation in the scheme.

To contextualise the scheme with other national initiatives aimed at supporting NMAPH

research careers and to identify key areas for learning (obj. 5), we undertook 2 semi-

structured interviews with senior staff involved with other national NMAHP initiatives. The

emerging findings from the evaluation were shared with participants in advance of these

interviews. The document acted as a starting point for discussions around how the CLAHRC

North Thames Fellowship Scheme compares to schemes they offer, to any similar examples

of best practice or mutual barriers, and then lead into a broader discussion about

supporting NMAHP barriers more generally.

These interviews focused on identifying areas for mutual learning with a view to running

future iterations of the scheme.

2 Out of a possible five fellows (one chose not to participate) 3 Out of a possible five interviewees (one per fellow) 4 Comprising Senior Clinical Academics, funding partners, training leads.

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Ethics

As a form of evaluation, the project was deemed to be exempt from NHS and UCL

institutional ethical approval. All participants provided written consent to participate.

The report was shared among research participants and the HEE north central and east

London Steering Group committee for comment.

The codes given to each interviewee indicate the order in which the interview took place,

and do not relate to the fellow, their supervisor, line-manager on a location or case-based

labelling system.

Analysis

Framework analysis was used. Transcripts were analysed for themes by stakeholder group,

and then key themes were compared across datasets in order to provide a rounded view of

any points or issues raised, in view of the objectives of the evaluation.

Questionnaires were read and the number and type of publication, training attended, and

capacity-building activities undertaken by the fellows were recorded as simple metrics.

Key Findings

Fellows – experience of participating in the scheme and impact of scheme on

their research career

Of our first two cohorts of fellows, four out of five were shortlisted for either a DRF or C-DRF

NIHR fellowship.

Table 2: Fellows

Fellow Journey

Fellow01 AHP Shortlisted, awarded CDRF

Fellow02 Nurse Not-shortlisted

Fellow03 Nurse Shortlisted CDRF

Fellow04 AHP Shortlisted, awarded DRF

Fellow05 Nurse Shortlisted DRF, Shortlisted CDRF

(withdrew)

Fellows who engaged in the scheme were ambitious to develop a clinical academic career

and had developed a keen interest in research throughout their careers, often starting out

with audits which had led them to identifying areas in their clinical roles where they wished

to make a difference to patient care:

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So I’d done research throughout my career, I’d done posters and taking part in audit

and those things, but after doing that piece of [Masters] research and it being successful I

decided I wanted to take that further (Fellow02);

audit’s always included in every part of your education pathway, and I think

sometimes these audits naturally turn into bigger questions … and I think that’s where you

know, that’s where I first started thinking about research…and in my clinics I kind of started

asking myself questions about you know how we can improve patient care (Fellow04).

The scheme was viewed as positive because it was funded and enabled participants to

engage in training without taking a cut in income:

I already had a Masters, I was not going to take any more, I could not take any more

unpaid time for education […] So I was only really able to take on opportunities that allowed

me to keep on working at the same rate instead of sort of set me back you know, so the

fellowship really stood out as different (Fellow01).

The fellowship buys the fellows out of their clinical practice to allow them time to develop

an application in a way which would have been difficult had they being trying to

accomplish it whilst employed full-time in a clinical role:

I wanted to apply for the NIHR PhD fellowship, but it's just so difficult to get the time

to think when you work in a very busy clinical environment. So that was the ideal

opportunity really and when I saw the advert ... and then the other positive aspect of that

was that it was in the CLAHRC, so it's very supportive environment (Fellow03).

A further benefit of the scheme was that it allowed fellows time to experience and

consider whether they wished to continue in a clinical academic role:

it was a really, really positive experience, I really enjoyed it, it was really

stimulating…I learnt loads, I think it really helped with my confidence and helped, I do want

to follow a clinical academic career, I do know that (Fellow02);

I loved it, I would jump at the chance to do more, to take three more years and I

would continue to try and manage that clinical research life because I still want to be a

clinician. So yes I would definitely, I have loved it, I have loved the opportunities to keep

going with the ideas, I have loved the learning curve (Fellow01).

Fellows also spoke about it aiding their development as a clinician. Firstly, that patient

care could improve as a result, and secondly that as a clinician their skills were enhanced by

it:

I couldn't help but identify and like play emphasis on the areas where there was a lot

of research where I needed to do something about it… the heat spots, you know, like the

areas where the research was really good actually were kind of driving me to make changes

in the service (Fellow04);

I am much more immersed in the evidence, I think I was already reasonably good at

evidence around my particular area, I tried to stay on top of it, I follow on twitter, all the

relevant kind of links and stuff like that but I am much better now and I also had some really

amazing collaborators and supporters (Fellow01).

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In line with our goal to build research capacity across the CLAHRC, fellows have been

involved in a range of work to raise levels of research awareness in their base NHS Trusts.

During the fellowship year, they undertook a wide range of capacity-building activities in

their host organisations, totalling over 40 different activities. These included making

presentations to colleagues about their projects, mentoring colleagues to propose and

conduct evaluations, facilitating ‘writing for publication’ workshops and journal clubs and

increasing awareness of good research practice. Three fellows were involved in planning

and implementing aspects of their host trust’s research strategy, with two incorporating a

greater focus on research into their role upon return to working full-time within the clinical

team.

All five fellows participated in activities promoting clinical academic careers and research,

outside of their host organisation. Examples include writing for the national CLAHRC

newsletter, as well as presenting to post-graduate nursing students and potential fellowship

scheme applicants, securing a bid for £10,000 to support research in their area of specialty,

and being involved in the organisation of a new Research Centre partnership. Other

activities in research included being part of national audits, contributing to NICE

evaluations, piloting the CLAHRC Academy’s online evaluation course, and becoming editor

of a specialist nursing textbook.

The scheme has helped to improve communication and partnership working between

clinical and academic staff. Fellows have taken part in conferences and symposiums linked

to their area of research. They were also involved in many other engagement activities such

as presenting their work at HEE/CLAHRC Stakeholder meetings, and at meetings with

potential research collaborators. Collaborations for current and future research projects

were formed with one charity, three UK universities, and one European university, as well as

CLAHRCs, CLAHRC North Thames partners, and NHS Trusts. The fellowship enabled fellows

to produce a substantial number of research outputs. Between the two cohorts, fellows

worked on 10 publications aimed at a variety of journals, including open access

multidisciplinary journals, specialist journals, nursing journals and protocol journals. One

fellow was also invited to write an editorial for a specialist journal. Four fellows presented at

conferences, with 7 posters and two talks in the UK and two presentations at conferences in

Europe.

Finally, fellows have used their research directly to improve care for patients, for example,

by undertaking improvement evaluations. Fellows have actively engaged with the CLAHRC

PPI group to obtain feedback on the development of their research proposals to ensure that

the research outcomes benefit patients, service users and those close to them. Fellows

embraced the training opportunities available to them. They completed 14 courses and

workshops, 9 training conferences and attended multiple seminars, these included training

on mix-methodologies, systematic reviewing, writing for publication, critical appraisal,

patient and public involvement in research, and statistics.

Participation in the scheme opened up new opportunities, in addition to PhD. Some

fellows moved jobs into new (more senior) roles, and this should be recognised as an

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additional outcome of the fellowship. The scheme offers a taster of a clinical academic

career, but is also a stepping stone and opens up new pathways, both clinical and in

research, by equipping fellows with new skills:

I have got this post which is a promotion and I think that it has impacted quite a lot

on a lot of my skills I would say, so stuff around critical thinking skills most definitely,

presentations, confidence, talking in meetings and confidence generally (Fellow02);

I’ve got a very exciting new job so I had my appraisal with my boss because I’ve

achieved so much in this year while I’ve been on the scheme in terms of building up this

collaboration and research and doing so many things like helping mentor so many valuable

audits and the evaluation project … I’m being given a new role so I’m going to be upgraded

and put in a kind of research co-ordinator [role] (Fellow04).

Despite the very positive experiences of participating in the scheme, the fellowship year

was not without its challenges. For the fellows, these related in the main to the difficulties

working across a clinical and academic role and maintaining a presence in both positions.

Fellows - Working across a clinical and academic role

The fellowship requires fellows to be seconded out of their clinical roles for 0.8 FTE, leaving

them remaining in practice for one day per week. Fellows enjoyed having protected time for

research. However, there were challenges in moving between clinical and academic roles.

Firstly, there were challenges adjusting to a new role:

As a nurse it’s like you’re on the ward, here are the jobs, go off and do them,

something else will come in, this will happen, that will happen…the space that you’re given

to think in an academic environment is just completely different, completely, that’s what

people just want you to do is read stuff and think about it and then come up with ideas...I

think that transition was really quite difficult. (Fellow02);

Well at first I found it really frustrating and I felt like I was going round and round in

circles, but I think that’s more because I … I always used to be in quite a senior position and

being a PhD student of a fellow is like you know, it’s not that at all, it’s a training … you know

it’s about learning and it took me a long time to get that mind-set (Fellow04).

Getting used to receiving critical feedback was something noted by a number of fellows:

quite difficult at first, is the criticism which isn’t directed at you, it’s directed at the

applications and stuff like that, but in academia it’s like they will just rip it to shreds which is

fine and when you look back you think yeah that’s a really good way… but that can be quite

hard at first, but I guess that’s another skill that you learn as well isn’t it? (Fellow02).

In supporting them in their transition, fellows suggested that when they stepped into the

role on Day 1, they should be fully prepared and logistics in place; for example, access

should already have been set up for them in their Research Department:

The only thing I would say was getting the paperwork and the ID card and computer

access and library access, it took three months to get that. And no one knew who I am, what

type of secondment I had, what type of contract I needed and again I think it's worth

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preparing in advance of these things. Because when ... you have a year, if you waste three

months trying to sort out your ID and library access it's not good (Fellow03).

Along the same lines, a ‘welcome pack’ of need-to-know information would also be useful:

I think there needs to be, I would like to see like a little package of information of

what you can expect and key resources that you need to kind of go to because I think you

kind of muddle through and find it out, but I was sort of finding out things in June and July

that I could have done with knowing in February you know what I mean? (Fellow01).

Removing themselves from a busy clinical department to concentrate on their research

was also a challenge. Fellows spoke about feeling guilty that they were leaving an often-

strained service behind:

at the beginning I guess in some ways I felt guilty about not being here and having

this amazing experience and then other people struggling, so it can be quite difficult

(Fellow02).

Often they compensated for being absent from their full-time clinical role by working long

hours and extended days. This could impact on other commitments, such as family life:

I mean I tried to isolate my clinical day on a Friday which often ended up being a 12

hour day because one clinic is never one clinic, there is always more things to do and when

you're around people ask questions, patients ring. So it's not just the nine patients you see in

the morning. (Fellow03);

Just the volume of emails I get from [the Clinic] is you know really phenomenal I’ll

probably get a day’s worth of emails from the Trust a week you know like to read through

and thankfully I’ve got remote email and so I can use like train journeys and weekends but

that’s slightly eating up into my own time and my children’s time and I’m answering emails

when I’m at home and stuff so yeah, it’s tricky (Fellow04).

Linked to this transition, moving between different roles and identities was not easy,

particularly with regard to balancing their presence in clinical practice with their fellowship

role:

suddenly things go round you that used to go through you, you know what I mean

and you kind of find out about things after and that is quite challenging then you just have

to accept it, you are doing a different role (Fellow01).

Other issues included a lack of understanding in their Trust department as to the purpose of

the fellowship, which was sometimes seen as short term ‘studying’, rather than a positive

development opportunity for the immediate clinical department:

I think in some ways there’s a definite lack of understanding of what I was actually

doing, so people would talk about me being on a course, well I wasn’t on a course, at the end

of it, and so at the end of it are you going to have a PhD, well no, that would be nice, but it,

there’s a definite lack of understanding of those sort of things (Fellow02);

many people here were telling me that I'm a student. They said you are studying

now are you? Not really. So it's that perception (Fellow03).

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Take-home points

Successes: The scheme has been a success in supporting fellows to submit high quality

applications for NIHR fellowships (see table 2). Fellows embraced the training opportunities

available to them and attended a wide range of training events and workshops.

Capacity building: Fellows undertook many activities to raise research awareness in their

Trust and worked to feed back their learning to colleagues in the department.

Scheme opens up new opportunities: In addition to PhD opportunities, some fellows also

moved on into new (more senior) roles.

Returning to training: returning to a learning environment took a period of adjustment. A

front loading of information in terms of a ‘welcome pack’ or similar would be helpful.

Movement between roles: Moving between different roles and identities was a challenge.

For example, moving from a senior clinical position to a junior/student research role.

Difficulties of keeping one foot in both camps.

Fellows sometimes compensated for being absent from their full time clinical role: they

spoke about working long hours and extended days.

Not necessarily a research culture in clinical department: Lack of understanding as to the

purpose of the fellowship. Sometimes seen as short term ‘studying’ rather than a positive

development opportunity for the immediate clinical department.

The Secondment

Trusts were supportive in principle to the career development of the fellow, and to enabling

them to undertake the fellowship scheme. The main issue fellows faced when negotiating

a secondment was financial, but this appeared to be dependent on the individual Trust and

its situation:

It was a bit of a struggle because of the additional money that the Trust had to give

up and I think this Trust is always in special, this Trust has been in special measures, financial

issues literally as soon as, since I’ve ever worked here (Fellow02).

It was felt that perhaps the requirement for a financial contribution from the Trust could

have been made clearer at the outset:

I applied, we were all surprised when I got it and only then did they realise that they

would be paid for three days but I would be gone for four and my boss then got in trouble

with her boss for having agreed to that because it was a one day financial hit for a strained

NHS department and I think there was a little bit of, it was challenging to get around that

(Fellow01).

Returning to practice after the secondment could be difficult. Two fellows discussed how

they felt frustrated that they were not able to put their learning into practice, once they had

returned to a full-time clinical role:

the team here expected me to just slot in in the same way as when I left whereas the

service hadn’t changed, but I had changed, so I had changed immeasurably in terms of all of

the new skills and all of the things that I wanted to do and actually it was just that I’d just go

back in and do the job that I’ve always done and so that was really awful and really

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difficult… I think there’s a real lack of understanding of what I can now contribute

(Fellow02);

coming back, and that's been a little bit difficult because I lost my research aspect.

So previously I had health, 50 percent clinical, 30 percent research and 20 percent

professional development, and other activities. So I lost that. So I'm now doing five clinics a

week so it's more or less about 80 to 90 percent clinical and I have no time for research

(Fellow03).

These two cases illustrate the need to have clear communication from the start as to the

role the fellow can expect to return to, and how they can put their learning into practice to

benefit the service. Maintaining a closer contact with the service could help with this.

After completion of the secondment, fellows continued to meet with representatives from

HEE’s north central and east London team and receive mentoring for their career

development. Fellows commented that they appreciated this ongoing support during their

transition back to practice and beyond, but that they felt that the CLAHRC could have been

more involved in post-secondment mentorship.

Take-home points

Clarify upfront about fellows’ role when they return to practice: Transition back can be

hard. Map out early what is expected of fellows when they go back to practice, and stress

importance of Trust commitment to long-term career progression.

Returning to Practice: Some fellows had limited time for research once they returned to

practice. This made it difficult to maintain momentum.

Stronger CLAHRC/Trust communication: Fellows would benefit from more formalised

communication between CLAHRC and Trust at outset of scheme – e.g., agreeing before

the secondment the type of role the fellow can expect to return to, so that they are able

to use their knowledge. Negotiate what is expected of the fellow in both clinical and

academic roles from the outset (perhaps write this in the contract).

Mentoring: Informal mentoring continues after scheme finishes (currently with HEE’s

north central and east London team). There is scope to formalise this and involve the

CLAHRC.

The next section of this report addresses objectives 2-4, exploring the effectiveness of the

advertising and recruitment process, the impact of the fellowship scheme on base NHS Trusts

and their host research organisations, and the experiences of those involved in both

participating in and running the scheme.

Advertising and recruitment

The CLAHRC and HEE’s north central and east London team advertised the fellowship

opportunity through their networks and email distribution lists. Therefore, advertising and

recruitment largely relied on the cascading of emails by staff in organisations, and on

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targeting potential individuals who may be interested in the scheme. Relying on an email

cascade had shortcomings, and was recognised by every stakeholder group:

communication is much more challenging than you think it is and you think you send

things out to people. So we rely a lot on e-mail and that’s not always, it does get information

out to people, but it requires someone to act on it. If I am interested in this and I see an e-

mail about it, that might alert me, but if I hadn’t previously thought about it and just looked

at that, I must just press the delete button because I think that’s nothing. When you get

hundreds of e-mails (Senior Representative in Non-Participate Trust);

I think in terms of barriers the obvious one is do people even know it is out there, so

there is something about how is the opportunity advertised and disseminated so that as

many people as possible are hearing about this…I think in health organisations, depending

on the organisation, the structures may be such that information only gets so far and does

not necessarily get to the right people (Academic02).

This approach to advertising depended on many factors, and was hit-or-miss in reaching the

right individuals:

So in any organisation it depends on how seriously the person who receives the email

takes it; whether they’re around at the time when the email comes in and how they

disseminate it through their organisation (Steering Group01).

The scheme may benefit from receiving wider awareness, and making sure that key contacts

in an organisation know what the scheme offers, so that they can target their dissemination

accordingly.

The scheme is aimed at Nurses, Midwives and Allied Health Professionals, however,

although AHPs are trained in CLAHRC North Thames partner universities, there is no School

of Nursing in CLAHRC partner universities. This creates an additional barrier in terms

accessing a large cohort of individuals undertaking a Masters in nursing.

Word-of-mouth and identifying of individuals who may be interested in participating in the

scheme was a recognised avenue for recruitment:

The other thing is these sorts of things; it’s often word of mouth as well isn’t it? So

once someone’s applied for one of these and been successful they will tell colleagues and

friends, do you know I did this fantastic, and that word of mouth is often the thing that tips it

from being just an e-mail in a box that people aren’t paying attention to someone thinking

that’s what so and so was talking about, I need to look at that. So I suppose that’s about

people that have been successful with the fellowship scheme also helping to disseminate

(Steering Group01).

It was felt that the wording of the advertisement could be improved or clarified to

broaden the appeal of the scheme:

I have to say, initially when I saw the way it was advertised and the requirements and

so forth it very much led you to think that unless you were interested in those particular

CLAHRC schemes that you almost were excluded from applications. So if your interests were

elsewhere and they did not align with what was listed you could easily think actually I cannot

apply because I am not interested in any of those (Academic02).

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Take-home points

Scheme would benefit from wider awareness: Could link with Colleges and Chartered

Societies to get better coverage (e.g., RCN, CSP) when advertising the fellowships. There is

no nursing school in CLAHRC partner universities, although other AHP professions are

represented (e.g. Pharmacy).

Work on networks and forming a closer CLAHRC/Trust communication within the local

area: e.g., CLAHRC giving presentations in Trusts to raise awareness of the scheme.

Advertising materials: Make it clearer at the outset that applicants do not have to be tied

to a particular CLAHRC project, since this could be limiting, if potential applicants think it

does not fit within their research interests.

Timing of scheme

For the first two cohorts, the timing of the scheme meant that if they were to submit two

applications for NIHR funding during the year (DRF and C-DRF), then the first application

would need to be submitted not long into their secondment:

the fellowship starts in January, the C-DRF application is due in April. So basically,

you do not have enough time to learn before you get that application (Fellow01).

This timing also had drawbacks with regard to fellows having access to the same training

opportunities at their CLAHRC partner university as doctoral students.

PhD students normally start in October so she started in January so some of the

courses that she might have wanted to go on had already happened (Supervisor01).

The application the fellow submits is not guaranteed to translate into funding for a PhD.

There is a long waiting period between submitting an application for funding and hearing

whether or not the application has been successful. In the meantime, fellows returned to

their clinical role, and this could be a driver for change and new opportunities:

I’ve applied for a new job partly because I think it will serve better my ends as a

clinical academic, but also I can’t sit around waiting for the Fellowship to come because it

might not even happen (Fellow02).

Take-home point

Timing of fellowships: There were some drawbacks to the timing of the fellowship. In

relation to NIHR applications, there was not a lot of notice for fellows to put in a project

for NIHR CDRF scheme that year. The fellowship does not align with academic year, so

fellows potentially miss some early doctoral training opportunities. There is a long limbo

period between submitting a PhD application and finding out if it has been

shortlisted/successful – difficult for fellows returning to practice/moving on (to new jobs).

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Base NHS Trust experience of scheme

Although there was recognition that the HEE/CLAHRC Fellowship scheme was a good

opportunity in the long-term, for the fellow’s career development, for the department,

and ultimately for patients, releasing a senior member of staff for 4 days a week for a year

was a challenge for the frontline service:

for an individual to get any kind of Research Fellowship or sabbatical for teaching or

anything else, it’s obviously great for the individual from their own professional

development. And I think also, in the overall picture, it’s better for the Trust because we

have people doing this and then hopefully they bring back an increased awareness of

research, an increased ability to do research into the Trust. So I think everyone benefits and

then ultimately, of course, the patients benefit in the long-term. But the difficulty is there is

very little, there's no slack whatsoever in the system (Line Manager01).

There are conflicting demands where there is a pressure to deliver the service and to meet

patient demand, when losing one senior member of staff for a year and also desiring to

support individual staff development. Although the HEE/CLAHRC Fellowship backfills the

salary for 3 days a week, their host trust is required to contribute one day’s salary to the

scheme:

you’re offering three days paid, and one day there has to be the contribution of the

service. Contribution of the service is a problem and I know the thinking behind that was to

ensure that the service had some buy-in, but I think that’s extremely naïve given the current

climate within the NHS particularly for small Trusts (Academic04).

Some of these issues could potentially be addressed by reducing the academic days to 3 and

increasing clinical days to 2, and removing the requirement for the Trust to contribute 1

day’s salary to the scheme. Part of building a clinical academic is nurturing the ability to

work across roles. This might be easier facilitated if the fellow maintained a closer contact

with the clinical department:

four days is really taking them out of their service commitment and I can understand

why their colleagues feel that this is a bit of a jolly they’ve been on for a year and they’ve

really lost touch with their service colleagues and find it very difficult to get back in. Have

you thought about maybe reducing it to two days a week and then maybe you can get more,

you could afford to have more people on that course so your hit rate of success will probably

increase (Senior Representative Other Schemes02)

Having one fixed day per week was also limiting for the fellows, who could miss training

opportunities which fell on their clinical day. Having a more flexible approach to the clinical

time e.g. running 2 or more of their clinical days together to cover busy periods in the clinic

or to free up research time to attend specific training events, may be helpful.

Trusts benefited from fellows implementing their learning in their clinical practice

throughout the year:

it was so good and you could just see the changes, the ideas of what she had learnt

over the period, whenever she came back to work we were able to use some of the

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functionalities of things and tools to implement some stuff in A&E and on the wards as well

(Line Manager03).

However, there was also some recognition that success in the scheme would mean that

fellows move on from their role:

the main thing is if people take this as a career move, which it is, hopefully that they

do come back to the Trust and then we can implement what they’ve learnt rather than they

come back and get a little bit bored or whatever because things have moved on and they’re

back to where they are (Line Manager01).

One way to combat this and support fellows in implementing their learning into practice is

to have a contractual agreement with the Trust form the outset regarding how the fellow’s

role may develop to reflect their new learning:

be something that may actually go into a contract for the organisation that as it’s

coming from to say, how would you intend to use this person, give an example of how you

intend to use this person when they come back (Line Manager03)

Take-home points

Conflicting demands: Pressure to deliver service when losing one member of staff vs.

wanting to support individual staff development.

Planning: Stressed the need for the fellowship to be planned well in advance – timing can

be difficult with relation to working planning and arranging staff cover. Early conversations

and planning would help.

Maintaining communication: fellows can be isolated/lose touch, when they are in clinic

only for one day a week – discuss possible flexibility in the scheme, e.g., a flexible 1 day per

week.

Clinical/Academic days: In order to maintain a closer relationship with the clinical

department and ease the pressure on staff providing cover, consider revising the weighting

of the fellowship to 0.4FTE clinical 0.6FTE academic. More clinical time may help the service

and the fellows to feel less removed from the department, so that they can maintain clinical

relationships and integrate their learning into their everyday practice.

Financial pressures: Consider whether to reduce the need for the Trust to contribute 1

day’s salary to the fellowship scheme.

Supporting career development: Have early discussions with the Trust about how the

fellows will be expected to implement their new learning, and how their clinical role can

develop to reflect this.

Supervising a clinical academic fellow

Supervisors spoke about how motivated and enthusiastic their fellows were, and this led to

them having a positive experience of involvement in the scheme:

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She’s so enthusiastic and she’s buzzing with ideas (Supervisor01);

She threw herself into the department and I think we missed her afterwards

(Supervisor02).

However, they also identified training-needs for their fellows, particularly around writing

skills:

Things like writing skills, I guess we assume ... well, certainly I had assumed a certain

base-line of writing skills (Supervisor02);

teaching writing and actually how do you get someone who has probably had a

scientific background that has not involved very much writing at all, how do you get them,

unless they’re naturally gifted, into a position where they can write a coherent Fellowship

application or a coherent paper (Supervisor04).

There was also a recognition that the pre-doctoral fellows were not quite at the level of a

PhD student, but are more advanced than a Masters student, and having a clinical

background also provided a different type of student/supervisor relationship:

I think in terms of understanding how to supervise, it’s good for that. Because it’s a

different relationship to a young, junior PhD student or an MSc student and it’s a different

relationship to some of the medics that I’ve supervised (Supervisor 02).

There was also a sense of learning from the fellows, who brought with them a knowledge

base associated with working in a clinical environment:

it was just great to see her be able to get on and recruit, it seems that everybody’s

quite happy to use the intervention used to follow up and agree to doing qualitative research

so it has been fantastic from that point of view to have, to not have those hurdles that I’ve

been having in my own research so it’s been quite refreshing from that point of view

(Supervisor01);

it was such a pleasure to work with her and I learned loads and it gave me new

reflections on my own ... I did learn loads about [the fellow’s clinical area] which I never

knew before (Supervisor02);

I think it’s been an interesting experience, I think it’s made me reflect quite a lot on

my own experiences as a clinical academic (Supervisor04).

Take-home points

Training: Recognise that not all fellows are starting from the same skills set. They may need

additional support in skills such as academic writing.

Mutual learning: The relationship between supervisor and fellow has different

characteristics from that between student and teacher – there is capacity for mutual

learning, especially around working day-to-day in a clinical environment. This insight is

valuable for academics working in Applied Health Research.

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Steering Group – developing clinical academic fellows

The purpose of the Fellowship Steering Group is twofold. Firstly, it aims to oversee the

running of the fellowship as a whole, review fellows’ quarterly reports and progress, and

discuss how to address any issues and support fellows’ professional development. Secondly,

its purpose is to discuss more generally how to support Clinical Academic Career Pathways

for NMAHPs in the local area.

There was an overall recognition that the scheme is quite small and limited in resource:

Well, it’s tiny, it’s tiny, it’s costly and it’s going to be a real challenge to sustain it in

the future (Steering Group01).

However, there is a strong commitment to the scheme and there continues to be a need

for the scheme, recognising the contribution it makes to the overall clinical academic career

pathway of NMAHPs. It is important and has the potential to grow, once an alumni cohort of

fellows has been established:

It is only a small drop in the ocean and I guess that’s where my kind of circular model

comes in; it is a drop, but it ripples. That’s the story of our lives professionally I think and

actually when you’re talking, we forget. We’re talking about nursing, midwifery, all of the

AHPs, we talk about them as if they’re a group. They are nine professions, Healthcare

Scientists and all of the different groups within Healthcare Science; actually, that’s huge

(Steering Group02).

There is a need to build a greater awareness amongst local Trusts regarding the real-term

benefit of having a staff member undertake the scheme, thus potentially breaking down

some of the barriers to engagement as discussed above:

So at the application phase I think there's a challenge encouraging or supporting line

managers to understand what the benefits are by having essentially one day a week being

paid into a scheme that they don’t necessarily see an immediate return on investment

(Steering Group03);

Their leaderships skills, they look at their services in a different way and that should

be amazing, and they should be able to harness that if they want to. You grow research

awareness in their practice areas they want to mentor and support people. We should be

attaching that to our QI and service improvement folk. That’s the way we do it, I think.

We’re a bit sniffy about quality improvement and research, they’re two different camps. So,

some of the shouting about it I think is shouting about it in a much broader sense. What do

you get when you get a Fellow back? What does that look like, what does that mean, how

could we translate that (Steering Group02).

One way to address this could be through a closer working relationship between the Trust,

HEE’s north central and east London team and the CLAHRC, mapping out before the start of

the fellowship what the Trust can expect from the fellow during the secondment year, and

also, what kind of role the fellow can expect to return to, and how they can put their skills

into action.

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Take-home points

Cost: The scheme is quite small and resource intensive.

Size: In terms of the bigger picture, the scheme is just a ‘drop in the ocean’. Think about

how it can link in with other work going on.

Build a closer working relationship between HEE’s north central and east London team,

CLAHRC and the fellows’ NHS Trust: Early conversations around what the Trust can expect

from the fellow in terms of immediate and mid-term benefits may challenge some of the

issues above regarding a lack of understanding about what the fellowship entails and how

the fellows’ service can benefit in the short term. In addition, early mapping out of the role

the fellows can expect to return to would also allow them to maintain momentum with the

research- and capacity-building activities, and address some issues regarding the

frustrations of having limited time for research on returning to their previous role.

Location of the scheme in supporting NMAHP academic career pathways

The scheme bridges a gap between Masters and PhD, or PhD and Post-doc. It allows

Fellows time to think about research and learn research skills. It offers a ‘taster’ of a

Clinical Academic career:

it’s a fantastic opportunity for the right individual, at that point where the scheme

would be helpful to them, you know for their pathway and their career aspirations really …

you know it has got to be someone who is at that point in their clinical career, who could

drop to… one day a week clinical, who has got that sort of vision (Academic01).

The findings of this evaluation were not unique and chimed with the experiences of

others in their work to support Clinical Academic development. Developing good

communication and a close working relationship between the CLAHRC and the NHS

organisations was identified as an important task, which works very well, but it is time-

consuming and hard to develop those relationships:

I don’t know what the answer to that is other than I’ve tried all sorts. I think I get

quite … when I do get involved in nearly all of the interviews so I meet the clinical staff where

they’re be working clinically and prior to that all of our PhDs from our NHS organisations, all

the Directors of Nursing I know and I’ve obviously met and we talk about the next research

priority. So it kind of feels a bit more as if they’re involved in the decision about what the

research is (Senior Representative Other Schemes01).

Involving the NHS organisations in agreeing the research priorities of the fellowships was

identified as a key way to increase Trust buy-in of schemes, especially if the research would

help to tackle problems that are immediate to them in the service.

Academic-training for non-medical trainees was agreed to be a continuing challenge, and

was far less developed in terms of opportunities when compared to schemes available to

medics:

if you're looking at physios or nurses they're just torn between service and academia

and the problem is there’s no clear pathway or academic posts for these people. So, it is the

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perennial problem so, you know what you're saying is it's a problem everywhere and I don’t

know how one gets around that especially with the problems in the NHS at the moment and

the underfunding. (Senior Representative Other Schemes02);

in medicine we’ve got a reasonably long history of clinical academic development

and lots of different opportunities for doctors who want to take a clinical academic career

pathway to get into that. In nursing, midwifery and the allied health professions,

opportunities are extremely limited and there are very few nurses, midwives and allied

health professionals who are successful, particularly in being awarded fully-funded or part-

funded opportunities to pursue that kind of career (Steering Group01).

In terms of carving out a clear academic career pathway for NMAHPs, there was a

recognition that there needed to be strong leadership:

one of the things that I’ve looked at in the past is how we would create senior people,

in other words professorial appointments that were clinical academic joined and once you

had the people that were those role models then we would try to fill in all the way down the

chain if you like with more people in those positions that could work their way up, but

putting somebody in at a junior level and asking them to create the expectations and the

model is actually difficult (Academic03).

Carving a pathway as a solitary individual in a department was something which was difficult

for fellows to achieve:

I think the biggest difficulty throughout the whole process is that mismatch and

misunderstanding between the academic and the NHS Trust for me. I don’t know, I think

other people have far more of a, far more accommodating Trusts or far more understanding,

but for me here I feel often like I’m the only person who has done anything like this and the

only person thinking in this way and that can be really difficult and I think that is the hard

thing (Fellow02).

Developing a larger body of alumni fellows would enhance awareness of the scheme and

increase the pool of developing academics. Especially if this involved developing a wider

network of early career clinical academics across the UK:

we really want to promote the scheme to our colleagues, yeah, and make things

better for everybody else who goes through that. Because it's a lifetime opportunity, just to

take a year out to do research on something you would do in the evenings, it's great

(Fellow03).

Take-home points

Need to link in with, and start to carve out, a clearer academic pathway for NMAPHs:

Suggestions include creating a stronger Alumni network that champions the scheme. Many

participants suggested the need for role models and a clearer career pathway.

Networks: Creating a Clinical Academic Network for NMAPHs would help to mobilise and

motivate others. Alumni network to champion clinical academic careers. Link with other

schemes and pathways for medics/scientists to add up to the bigger picture of making a

difference to patients and public.

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Actions

References

AUKUH (2013) The Nurse and Midwife Research Clinical Academic: Development, Progress

and Challenges. Annual Report of Activity May 2011 to June 2012. The Association of UK

University Hospitals.

AUKUH (2016) Clinical Academic Roles Development Group (2016) Transforming healthcare

through clinical academic roles in nursing, midwifery and allied health professions: A

practical resource for healthcare provider organisations. The Association of UK University

Hospitals.

Boaz A, Hanney S, Jones T, et al. (2015) Does the engagement of clinicians and organisations

in research improve healthcare performance: a three-stage review. BMJ

Open2015;5:e009415.

Cooke J, Bray K, Sriram V. (2016) Mapping research capacity activities in the CLAHRC

community. National Institute for Health Research.

Department of Health (2006) Modernising nursing careers: setting the direction. London:

Department of Health.

HEE (2014) Developing a flexible workforce that embraces research and innovation:

Research and Innovation Strategy. Health Education England.

HEE (2015) Clinical Academic Careers Framework: A framework for optimising clinical academic careers across healthcare professions. Health Education England.

In response to some issues raised in the evaluation we have made the following adaptations to the scheme:

Formalised a ‘roles and responsibilities’ document, which fellows and their

supervisors must agree to and sign.

Encouraged ‘start-up’ meetings with fellows’ base Trusts in order to have early

discussions about how fellows can put their learning into practice throughout the

fellowship year.

Maintained informal mentoring with past fellows to cultivate an Alumni cohort.

Encouraged fellows to participate in wider CLAHRC capacity-building activities e.g.

contributing to the development and delivery of CLAHRC Academy short courses.

Fellows are leading the development of a general ‘resource pack’ for clinical

academic careers to be distributed at host Trusts.

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NIHR Trainees Coordinating Centre. TCC Personal Awards- success rates. Accessed on 30

August 2017 at: https://www.nihr.ac.uk/funding-and-support/funding-for-training-and-

career-development/training-programmes/TCC%20Personal%20Awards-

%20success%20rates.pdf

NIHR (2016) Cooke, J., Bray, K., and Sriram, V. ‘Mapping research capacity activities in the

CLAHRC community: Supporting non-medical professionals’ National Institute for Health

Research.

Ozdemir BA, Karthikesalingam A, Sinha S, Poloniecki JD, Hinchliffe RJ, Thompson MM, et al.

(2015) Research Activity and the Association with Mortality. PLoS ONE 10(2): e0118253.

UKCRC Sub-Committee for Nurses in Clinical Research (2007) Developing the best research

professionals. UK Clinical Research Collaboration.

Willis, G. P. (2015) ‘Raising the Bar. Shape of Caring: A Review of the Future Education and

Training of Registered Nurses and Care Assistants’ Health Education England.

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